PROJECT SUMMARY/ABSTRACT Hospitalizations for drug use-associated infective endocarditis (DUA-IE), an infection of the heart valves from injecting drugs, have increased sharply as a consequence of the opioid epidemic. DUA-IE is a severe disease that poses substantial morbidity to patients and burden to hospitals and insurance payers. Treatment typically requires long hospitalizations, six weeks of intravenous antibiotics and often includes surgical heart valve replacement. The post-hospitalization course of patients with DUA-IE has not been well-studied. During treatment, many patients? drug use disorders (DUDs) remain unaddressed, despite their central role in causing DUA-IE, leaving patients vulnerable to ongoing drug-related risks such as overdose and repeat DUA-IE. Understanding how to address DUDs for hospitalized patients with DUA-IE, particularly in areas with limited treatment resources, is critically important. The overall objectives of this work are to characterize DUA-IE patients? post-discharge course to understand the scope and timing of negative clinical outcomes, and to explore DUA-IE patients? perspectives to identify strategies to foster engagement in DUD and infectious disease care. In North Carolina, a Medicaid non-expansion state, we will evaluate three research aims: (1) Estimate incidence rates of and risk factors for adverse outcomes following hospitalization for DUA-IE including: drug overdose, readmission, reoperation, and all-cause mortality; (2) Explore knowledge, preferences, and perceptions of DUA- IE risk, post-hospitalization drug use, DUD treatment, and antibiotic options among hospitalized DUA-IE patients; and (3) Pilot a multicenter survey characterizing DUA-IE patients? knowledge, preferences, and perceptions of DUA-IE and DUD, access to care, and treatment preferences. Completion of these aims aligns with a training objective to obtain skills across five specific domains: (1) epidemiologic analysis of administrative datasets, (2) exploratory qualitative research, (3) developing and analyzing questionnaires, (4) collaborative, management and project development, and (5) the responsible conduct of human subjects research. This training will be accomplished through coursework, one-on-one instruction and guidance from a diverse group of mentors and advisors from across the University of North Carolina, Duke University and the North Carolina Division of Public Health, including experts in health services research for infectious diseases, DUD care, multisite studies of infective endocarditis and behavioral health. Completion of the research and training aims represent short-term career goals, but they will also form a foundation for my future academic endeavors. My long-term goal is to become an independent investigator with expertise in the infectious complications of drug use, and to be prepared to implement interventions and to answer new epidemiologic and behavioral questions that arise. This research and training plan is foundational to the future implementation and evaluation of an inpatient intervention to enhance post-discharge outcomes for DUA-IE, which I will propose in an R01 towards the end of the award as I transition to research and funding independence.